The Perfect Vision of Dr. V.

Aravind has managed to beat costs in every area of its service: The hospital's own Aurolab, begun in 1992, pioneered the production of high-quality, low-cost intraocular lenses. Aurolab now produces 700,000 lenses per year, a quarter of which are used at Aravind. The rest are exported to countries all over the world -- except to the United States. (In order for Aravind to get its lenses approved for sale in the United States, it would have to pay for an FDA study and a clinical study, which the hospital cannot afford.) Aravind even has its own guest house, and students and physicians from around the world come to teach, study, observe, practice -- and boost their training. Poles for stretchers? They're made from bamboo that grows in Dr. V.'s garden. "We also have the $5 pole, which is bright and shiny," says Dr. Natchiar, "but we prefer these bamboo poles."

They are proud of their fiscal conservatism, but this is not HMO-speak. This is pleasure in the knowledge that they are not seduced by money. "The health-care business is so bad," Dr. Natchiar says. Extravagant is what she means. "Alternative models are needed. There is a new machine used to help with surgery that recognizes the doctor's voice. It is egotistic. That's another $100,000, which the patient pays. You have to stop and think, Is this the best way to spend money? At our hospital, machines aren't doing the surgery; people are. We need technology, but medicine also needs the practices of the East."

When Dr. V. started, there were perhaps no more than eight ophthalmologists in all of India. Dr. V. saw a market in the 20 million blind of India, most of whom suffer from cataracts, which in India are caused mainly by the glare of the tropical sun, poor diet, and genetic factors. Today, Aravind is the largest single provider of eye surgery in the world. In 1998, its hospitals saw 1.2 million outpatients and performed 183,000 cataract surgeries. Dr. V.'s extended family visited 1,488 villages to run diagnostic eye camps. Paying customers support the free surgeries, and the sale of lenses abroad adds to the bottom line. Aravind accepts no government grants. The hospitals are totally self-sustaining. And Dr. V. lives on his pension. "There is not one rupee that he takes out of Aravind," says Dr. Natchiar.

Scissors and Thread and an Old-Master Painting in 10 Minutes Flat

"The surgery is an art," Dr. Natchiar says. "You work in such a tiny space, and if you create a beautiful job, the painting is worth so much money. You put pictures in people's eyes. You paint them stunning flowers, their children's faces, or lines that are clear and sharp."

11 AM: In pediatric surgery, a chubby, brown, five-month-old baby with double cataracts is fussing on the operating table. A surgical team begins to sedate the baby, massaging the infant's legs and arms, hovering, comforting. The head nurse tries to find a vein buried in the chubbiness. It's like trying to find a thread baked into a loaf of bread. After about five minutes of studious searching, she finds it and injects the first anesthesia. The baby settles a bit, and the nurse moves on to the other leg. The anesthesiologist attaches the breathing tube, and the infant's second surgery begins (the first having been done two days ago). The surgery itself is over in five minutes. "Babies' eyes are very soft, so the incision is very small," says the surgeon. After a few minutes, the baby is carried out to its mother and begins to wake up. This child is one of 2,500 whom Aravind treats every month.

Cataract surgeries are beautiful. Eyes never look old. From the TV monitors in the operating room, an eye looks like the globe of the bright blue earth, floating in a sea of white clouds. The doctors never make it more gorgeous. They only make it perfect; they do this by scraping out the film that clouds the retina. The eye turns brilliantly clear, the light pouring into it. An artificial lens is then positioned over the retina. There is no blood until the suture needle is inserted, then one thread of blood appears, as if the surgeon were sewing with this red line.

For the team in pediatric surgery, the morning has been routine, another brief, successful operation that will give sight to an infant. I, an outside observer, provide the morning's only unusual element. Dr. V. has assigned me my own private nurse, in case the sight of the operation makes me faint. I don't faint -- I wet through my surgical mask with tears. The surgical team has never seen this reaction before. But what I have seen -- five adults hovering over a tiny infant and light flooding into a once-blind eye -- is a study in selflessness, tenderness, and art that I have never seen before.

You haven't seen until you've seen Aravind. Whether you're a patient or an observer, your eyes are opened. You see in new ways.